Creating and Maintaining Therapeutic Boundaries

Someone recently asked me if performing massage was physically difficult. It was interesting to me as I can honestly say I usually feel the most alive, invigorated and peaceful when I am giving massage. That isn’t to say that giving a massage isn’t physical work or that it can’t take a toll on the therapist’s body! We know it does by the prevalence of injury among therapists, but we also know that much of that can be avoided with good body mechanics and not over booking our schedules! The question got me thinking about the greatest challenges we face as therapists and how we cope with them?

I find that the best massages I give and receive are always the ones that are done with intention and focus. To be truly present with another person takes effort and good communication. We have to balance our needs with those of our client’s. This is a perpetual practice and sometimes we are better at it than other times. I find that misunderstandings can occur when the balance is not maintained and it is during these, hopefully rare, moments that being a massage therapist is the most difficult.

It is the therapist’s, not the client’s, job to create and maintain the boundaries of the therapeutic relationship. These boundaries and expectations are most easily established at session #1 by having the client read and sign a Terms and Conditions statement with their other intake forms. I verbally review my terms of service with the client and give them a copy to take home. Taking this step can drastically reduce the likelihood of future confusion, but it doesn’t guarantee it, nor does it work if you do not stick by those convictions.

A few likely issues therapists may have with clients include:

Client who tend to be late or no show for appointments.

Clients who think you are awesome and really want to be your friend!

Clients who would like you to work deeper than you feel comfortable working.

Clients who “forget” their checkbook/credit card/purse.

Clients that you just don’t have a good “fit” with for personality/personal reasons.

Clients who are friends first and take advantage of you as a therapist.

On the other hand, clients may have issue with their therapist if:

The therapist is late or no shows appointments.

The therapist over shares too much personal information taking the focus away from the client.

The therapist does not gauge pressure correctly and works too deep or too lightly.

The therapist changes rates without notifying the client before the service.

Poor “fit” for personality/personal reasons.

Therapists who were friends first and do not create the professional space for the friend as they would for other clients.

As a therapist you have to monitor yourself to ensure you are creating the therapeutic boundaries you expect to be maintained. You can’t really be upset with a client for being late if you never start your sessions on time! Nor can you expect them to treat you as a professional if you tell them all about the wild night you had last week. You set the example! Having a no show or late policy that clearly states that there is a cancellation fee and that late appointments forfeit the time missed put the policy in place, but it is still your responsibility to enforce them! Regardless of the scenario, awareness and clear communication are key! If you have an issue with a client, speak with them about it in a calm, non-judgmental tone. Refer back to your Terms and Conditions form that they signed and express your expectations openly and honestly. You may not have a good “fit” if the client can’t appreciate or accept what you are asking. In these cases you may need to let the client know that there isn’t a good “fit” and refer them to someone else.